选择性动脉栓塞术治疗顽固性鼻出血

目的探讨顽固性鼻出血的血管造影特点以及选择性动脉栓塞术治疗的临床疗效、并发症及注意事项。方法对16例顽固性鼻出血患者行选择性颈外和（或）颈内动脉造影术及选择性上颌动脉和（或）面动脉栓塞术。栓塞剂为明胶海绵颗粒（条）、弹簧圈。结果 16例患者中,15例动脉造影见阳性征象,1例为阴性。栓塞靶血管后,14例止血效果良好;对2例合并筛动脉出血患者于栓塞术后次日行筛动脉结扎术,出血得到完全控制。所有患者均未出现与栓塞相关的严重并发症。结论选择性动脉造影及栓塞术可快速诊断及有效治疗顽固性鼻出血;对有筛动脉参与的鼻出血,应结合动脉结扎手术进行治疗。     

经导管颌内动脉、面动脉栓塞治疗顽固性鼻出血

目的探讨动脉栓塞治疗顽固性鼻出血的临床效果、并发症及注意事项。方法对8例顽固性鼻出血患者进行超选择性颌内动脉和（或）面动脉栓塞。结果8例患者均立即止血。所有患者均出现程度不同的头痛症状,但无严重并发症发生。结论经导管颌内动脉、面动脉栓塞对顽固性鼻出血是安全、有效、快捷的介入治疗方法。     

超选择性动脉栓塞治疗严重鼻出血

目的观察超选择性动脉栓塞治疗严重鼻出血的临床效果和并发症。方法对22例严重鼻出血患者进行超选择上颌动脉造影,证实出血部位后用明胶海绵、真丝线段栓塞出血动脉。结果22例患者均发现出血动脉,栓塞后达到立即止血目的,1例于栓塞后30min发生右侧眼睛视野中间区域缺损,扩血管、皮下注射肝素钙,注射后30min视野逐渐恢复,3h后视野完全恢复正常。结论超选择性上颌动脉栓塞治疗严重鼻出血具有止血迅速、效果确切、创伤小、恢复快的优点,可作为治疗严重鼻出血的常规手段,在治疗严重鼻出血时应积极使用此项技术。     

鼻出血介入治疗的护理体会

目的:探讨数字减影超选择性血管内栓塞治疗顽固性鼻出血的护理经验和体会。方法:总结26例鼻出血患者行介入治疗的护理要点及过程,以期提高疗效。结果:26例患者均一次性栓塞止血成功。结论:全面细心的护理提高了患者对手术的配合程度,减少了并发症,手术效果良好。     

创伤性泌尿系出血的急诊动脉栓塞治疗

目的探讨经导管选择性动脉栓塞在创伤性泌尿系出血急诊治疗中的价值. 方法 1998年1月～2003年6月对27例创伤性泌尿系出血根据损伤出血部位行数字减影血管造影检查,明确出血动脉,明胶海绵颗粒或弹簧钢圈栓塞靶动脉. 结果 23例一次栓塞成功止血,2例2次栓塞后止血,2例栓塞失败改行其他治疗方法.栓塞后不良反应为发热16例,局部疼痛、恶心、呕吐14例,1例髂内动脉栓塞出现一过性臀部疼痛. 结论选择性动脉栓塞是治疗创伤性泌尿系出血的有效措施,具有创伤小、见效快的优点,为进一步治疗创造条件.     

顽固性鼻出血的血管内栓塞治疗

目的探讨经导管动脉栓塞治疗顽固性鼻出血的临床价值。方法对21例经前后鼻腔填塞和（或）鼻内镜下止血后无效的鼻出血患者,经血管造影明确责任动脉后行血管内栓塞,所有病例随访30天。结果21例鼻出血患者中,20例成功实施栓塞治疗,技术成功率为95．24％（20121）,1例假性动脉瘤造影时动脉瘤破裂患者死亡;16例栓塞后活动性出血停止,4例仍有少量出血,结合内科治疗后出血渐止,栓塞有效率100％（20／20）。所有病例随访30天内均无再发出血;16例栓塞后无并发症出现,3例术后出现头痛、发热、颌面部胀痛等,1例出现右眼视野缺损。结论对于顽固性鼻出血,经导管动脉栓塞是一种安全有效的治疗方法。     

选择性颈外动脉栓塞治疗鼻出血的临床分析

目的探讨数字减影血管造影（DSA）和选择性颈外动脉栓塞在难治性鼻出血的诊断和治疗方面的临床意义。方法回顾性分析总结31例难治性鼻出血的患者行选择性颈外动脉栓塞治疗的有关资料。结果37例患者中31例栓塞成功．其中3例栓塞2次．6例造影后行手术治疗。未见明显失明、偏瘫等严重并发症。部分患者有张口受限、发热、颜面部麻木等不良反应。术后随访1-3月,无明显复发。结论DSA和选择性颈外动脉栓塞治疗难治性鼻出血是一种安全、有效的诊断和治疗方法,并为部分耳鼻喉科的手术开辟了一种新途径。     

超选择性动脉栓塞治疗泌尿系损伤大出血的价值

目的 评价超选择性动脉栓塞治疗泌尿系损伤大出血的效果和临床价值.方法 对12例泌尿系损伤大出血病例进行超选择性血管栓塞治疗,包括骨盆骨折合并尿道损伤大出血4例,经皮肾镜取石术后大出血6例,肾挫裂伤大出血2例,在数字减影血管造影(DSA)下,9例用明胶海绵条或颗粒,3例用金属弹簧进行超选择血管栓塞.结果 所有病例栓塞后出血停止,血流动力学趋于平稳,尿管引流尿色变淡,6～48h后尿色转清.术后随访2～12个月,无再发大出血病例,无勃起功能障碍,肾血管栓塞患者术后10～12个月IVU检查未见明显肾功能损害区.结论 超选择性动脉栓塞治疗泌尿系损伤大出血具有创伤小、安全、止血迅速、效果好、能最大限度地保留器官功能等优点,值得临床推广应用.     

髂内动脉栓塞治疗难治性产后出血——附5例报告

目的　探讨髂内动脉栓塞治疗难治性产后出血的临床价值。　方法　用介入放射技术对 5例产后出血患者行骼内动脉数字减影血管造影 (DSA) ,明确盆腔血管走向及造影剂由血管外溢情况 ,以明胶海绵碎粒与稀释之造影剂混合栓塞双侧髂内动脉。　结果　 5例经髂内动脉造影均显示了不同临床原因引起的出血图象 ,经栓塞后出血随之停止 ,但 1例腹腔再度出血 ,剖腹探查发现为右侧卵巢血管及圆韧带残端出血。　结论　髂内动脉栓塞技术应用于难治性产后出血能迅速止血 ,保留子宫 ,抢救病人生命     

DSA和介入栓塞术在急性动脉性出血诊断与治疗中的应用

目的探讨数字减影血管造影和介入栓塞术对急性动脉性出血的诊断与治疗价值。方法急性出血患者22例，包括肝脏损伤出血4例，产后大出血7例，人流术后出血2例，大咯血6例，消化道出血3例。对出血部位行选择性DSA，明确诊断及出血动脉后在超选择插管基础上行栓塞治疗，栓塞材料为明胶海绵颗粒和／或聚乙烯醇颗粒。结果所有病例DSA均显示出血阳性征象，表现为造影剂外溢。22例栓塞治疗后出血均立即停止，随访3～24个月，1例大咯血患者在治疗后第4个月出血复发，遂行二次栓塞止血。未见严重并发症发生。结论DSA对诊断急性出血有较高的价值；介入栓塞术微创、并发症少，能迅速、安全、有效地控制出血，宜作为急性出血治疗的首先方法。     

建立黑山羊陈旧性心肌梗死模型的新方法

目的建立能长期存活的山羊心肌梗死实验模型。方法16只黑山羊,体重15~24kg,3~6月龄,雌雄不拘。均行剑突下切口,倒V字形切开胸骨下段,于左冠状动脉前降支中下1/3用5-0prolene线8字缝合包绕伴行静脉,阻断5min,再间歇3min,重复两次进行缺血预适应,然后结扎左冠状动脉及伴行静脉,建立羊心肌梗死模型。描记心电图,于建模前及建模后1、3、6、12、24、48h抽血检测血清肌酸激酶同工酶(creatinekinase-MB,CK-MB)及脂肪酸结合蛋白;并于模型建立后6周行心电图、超声心动图、选择性左冠状动脉造影、透射电镜及心肌梗死面积测定。结果造模过程中无实验动物死亡,造模成功率为100%。CK-MB于建模后3h开始升高,12h达高峰;脂肪酸结合蛋白于建模后1h开始升高,12h达高峰。建模后结扎点下方心肌逐渐出现片状紫红色区域,心电监测仪提示、、V3导联明显ST段上抬及T波改变,建模后6周,相应导联均出现明显病理性Q波;心脏超声检查显示左心室腔明显扩大并见室壁瘤形成;选择性左冠状动脉造影检查见心尖区血管纤细,外形呈瘤样扩张。透射电镜见梗死区肌丝溶解、断裂,排列混乱,细胞器崩解聚集。心肌梗死面积为4.74±0.78cm2。结论黑山羊是建立心肌梗死模型较好的实验动物;经剑突下切口,倒V字形切开胸骨下端入路,结扎左冠状动脉前降支中下1/3,是建立能长期存活的陈旧性心肌梗死模型简便、安全可靠的方法。     

超选择性肾动脉弹簧圈栓塞治疗经皮肾镜术后出血的临床研究

目的分析超选择性肾动脉弹簧圈栓塞术(SRACE)治疗经皮肾镜碎石取石术(PCNL)术后严重出血的时机选择、安全性和疗效。方法回顾性分析贵州省人民医院2013年10月至2019年3月38例PCNL后严重出血患者的出血特点、数字减影血管造影(DSA)表现及栓塞后肾功能检测情况。结果38例患者中,7例未观察到确切出血点,31例DSA表现为肾动脉性出血,其中动脉撕裂6例,单纯假性动脉瘤(PA)17例,动静脉瘘(AVF)4例,PA合并AVF 4例。根据肾脏血管解剖位置定位,肾动脉上极支出血4例,中极支出血9例,下极支出血18例。急性出血2例,其中1例经SRACE联合输血等治疗后未能有效控制出血而行患肾切除术,迟发性出血20例,缓慢持续性出血16例。31例患者中30例成功栓塞,成功率为96.8%。SRACE术前与术后的肾小球滤过率(P=0.173)、血清尿素氮(P=0.969)、血清肌酐(P=0.180)差异均无统计学意义(P>0.05)。结论急性出血应尽快行DSA明确诊断后行栓塞治疗,迟发性及缓慢持续性出血经保守治疗无效,DSA/SRACE可作为首选的检查方法及治疗方法,SRACE是安全有效的治疗方式。     

血管损伤的外科处理

目的: 探讨血管损伤的外科处理方法。方法:分析总结59例血管损伤的临床资料。颈部及四肢血管损伤55例，门静脉及下腔静脉损伤4例，其中股动脉损伤并感染21例，介入并发血管损伤4例。四肢或颈部血管破裂或横断病例入院前多已给予压迫止血或抗休克治疗。所有股动脉损伤并感染病例均行血管结扎并脓肿引流术，其余患者根据病情行对端吻合术（11例），血管移植术（12例），血管修补术（14例）。结果:死亡2例；截肢5例（其中1例介入治疗误栓股动脉）；21例股动脉感染破裂者术后出现间歇性跛行、皮温低等缺血表现，但无1例下肢坏死；其余患者均痊愈出院。结论:血管损伤首先应立即给予局部止血或抗休克处理，以抢救患者生命，再根据血管损伤情况进行处理，尽可能保存肢体。血管重建是血管损伤的主要治疗手段，股动脉损伤并感染者可行动脉结扎术。     

Dissecting aneurysm of the posterior cerebral artery treated with proximal ligation.

A rare case of a dissecting aneurysm of the P3 segment of the right posterior cerebral artery is presented that seems to have occurred in association with mild head injury. The patient was treated surgically because of repeated intramural hemorrhage and enlargement of the aneurysm. Proximal ligation produced thrombosis of the aneurysm without resulting in infarction in the region of the posterior cerebral artery. The mechanisms of the dissection, diagnosis, and treatment are briefly discussed.     

Non-traumatic dissecting aneurysms on the intracranial internal carotid artery: report of three cases

Subarachnoid hemorrhage (SAH) due to non-traumatic dissecting aneurysms is uncommon. Most of such cases are reported to occur in the posterior circulation. We encountered three cases of non-traumatic dissecting aneurysms on the intracranial internal carotid artery. Two cases developing SAH from the dissecting aneurysms were surgically treated by such means as proximal ligation and trapping. Two cases, which were treated surgically during the acute phase, showed poor surgical outcome, because a large cerebral infarction took place during the course of vasospasm. Trapping of the ICA or the contralateral ICA with the dissecting aneurysm failed to keep enough blood supply despite hypervolemic hypertensive therapy. Operative results seemed to depend on the collateral circulation during vasospasm, so appropriate bypass surgery was recommended in cases of dissecting aneurysm on the ICA manifesting SAH. Furthermore, the mechanism of initiation of a dissecting aneurysm on the intracranial carotid artery was discussed from the biorheological aspect.     

Laparoscopic ligation of the median sacral artery before resection of a sacrococcygeal teratoma

To minimize the risk of exsanguinating hemorrhage, the authors describe a technique of laparoscopic ligation of the median sacral artery before posterior sagittal resection of type I sacrococcygeal teratoma (SCT). Two female infants with antenatally diagnosed SCT underwent postnatal evaluation and preoperative imaging and were taken to the operating room. In both patients, pneumoperitoneum was established via an epigastic 5-mm trocar. Two additional trocars were inserted in the right and left lower quadrants. The peritoneal reflection was opened to the right of the sigmoid colon, and the presacral space was explored. A large median sacral artery was identified easily, isolated, and divided. The children then were placed in a prone position, and the tumors underwent en bloc resection via a Chevron incision with minimal blood loss. The laparoscopic portion of the procedure was performed in an average of 15 minutes. This is the first report of laparoscopic ligation of the median sacral artery before posterior resection of a sacrococcygeal tumor in an infant. This technique can be performed easily with minimal morbidity. Division of this artery is a logical preventative measure and may reduce the risk of hemorrhage during operative resection.     

Massive arterial hemorrhage in patients with pancreatitis. Complementary roles of surgery and transcatheter occlusive techniques

Massive arterial hemorrhage from multiple sites caused by tissue injury and infection following severe pancreatitis occurred in 12 patients, who were treated with the combination of angiographic embolization techniques and surgery; five survived. Complete hemostasis was obtained in eight of 12 patients who underwent primary angiographic therapy. Bleeding was temporarily controlled in two patients, who then underwent directed surgical ligation of the bleeding vessel under more favorable conditions. In two patients, bleeding was not controlled. The use of permanent occluding materials, particularly bucrylate, resulted in the highest success rate. When the bleeding artery could not be individually catheterized for safe occlusion, balloon occlusion or vasopressin infusion stabilized the patient's condition, with a decrease in the rate of bleeding prior to subsequent surgical therapy. Inadequate control of further tissue necrosis and sepsis was the cause of death in five of the seven patients who died. The other two patients died of recurrent hemorrhage despite attempts at both arteriographic occlusion and surgical ligation.     

Transcatheter embolization in the treatment of massive bleeding due to maxillofacial injury

Thirty-one cases of massive bleeding due to blunt maxillofacial injuries were treated by several procedures. Blind techniques, such as nasal and/or oral packing or ligation of external carotid artery, failed to achieve hemostasis in 13 of the 18 cases (72.2%) in which they were employed before 1984. Since then, carotid angiography has documented the location of the bleeding in 12 of the 13 cases (92.3%) in which it was employed. Each of the four cases in which extravasation was visualized from the external carotid artery was successfully treated by transcatheter embolization. We conclude that selective, angiographically guided embolization can reliably achieve hemostasis in a high proportion of patients with maxillofacial injury who are in danger of exsanguination from the branches of the external carotid artery.     

经肝动脉骨髓干细胞移植治疗肝硬化的初步临床应用

目的探讨经肝动脉自体骨髓干细胞肝内移植治疗失代偿期肝硬化的临床应用可能性及效果。方法20例失代偿期肝硬化患者，乙型肝炎后肝硬化19例，酒精性肝硬化1例。Child—Pugh分级：A级2例，B级6例，C级12例。所有患者术前均行影像学及肝脏功能等检查。移植术当日抽取患者自体骨髓30～50ml，分离出骨髓干细胞，经肝固有动脉注入。对于造影发现肝内有单发小肝癌者，先行肝段超选择TACE治疗，再选择性插管至正常肝动脉供血区，注入骨髓干细胞。术后1周、2周、1月观察患者临床症状、体征，复查肝功能等实验室指标。结果2例造影发现合并单发小肝癌。20例患者中，14例有效，6例无效。所有病例术后均未出现发热、过敏反应及其他不适。结论经肝动脉行自体骨髓干细胞移植安全可行；部分肝硬化患者用此方法治疗近期有效；治疗中通过肝动脉造影可能发现其他影像学检查未能显现的早期肝癌。